ACUTE GLOMERULONEPHRITIS
1. Diuretics: metolazone (zaroxlyn), Furoseonide
Also called acute poststreptococcal glumeronephtriris,
AGN is a relatively common bilateral infection in the
glomeruli, the kidney’s blood vessels. It follows a
streptococcal infection of the respiratory tract or, less
often a skin infection such as impetigo.
CAUSES:
1. Trapped antigen-antibody complexes (produced
as an immunologic mechanism in response to
streptococci) in the glomenular capillary
membrames; including infalmmatory damage
and impeding glomenular function.
2. Untreated pharyngitis,/ tonsilitis,impetigo,and
scarlet fever.
CLINICAL MANIFESTATIONS:
 Azotemia ( nitrogen in blood)
 Edema
 Fatigue
 Hematuria
 Oliguria
 Protenuria
 BP (NS is BP)
PATHOPHYSIOLOGY
Antigen (group A-Beta hemolytic streptococcus)
Antibody-antigen complex formation in glomerolus
Inflammation of glomerular basement membrane
blood supply and oxygen in the glomeruli membrane
necrosis and injury to glomerulus
space in glomerular membrane
glomerular filtration rate
protein can pass through to the filter
proteniuria
hypoprotenuria
capillary oncotic pressure
shifting of fluid into interstitial space
edema
DRUG THERAPY:
(lasix) to reduce extracellualr fluid overload
2. Antihypertensives: hydralazine
RELATED LABORATORY FINDINGS:
1. Blood Test: crea
2. 24-hr urine sample: crea clearance and imparied
glomerular filtration
3. Antitreptolysin-O titers (in 80% of patients)
streptozyme and anti-Dnase B titers
serum complement levels verify recent strep infxn
4. Renal Biopsy: may confitm that dx may be used to
asses renal tissue status
5. Renal Utz: may show normal/enlarged kidney
6. Throat Culture: (+) group A beta-hemolytic strep
7. Urinalysis: typically reveals protenuiria and
hematuria. RBCs, WBCs and mixed cell casts are
common findingsin urinary sediment
8. KUB X-ray: bilateral kidney enlargement
NURSING MANAGEMENT :
1. Check VS and electrolyte values. Monitor I&O daily
wt. Asses renal function daily through serum crea
and BUN levels and urine creatine clearance.
Watch out for signs of acute renal failure (oliguria,
ozotemia, acidosis) These measures detect early
signs of complications and help guide the
treatment plan.
2. Consult the dietitian to provide a diet cal, pro,
Na, K and limited fluids.
3. Provide good nutrition, use good hygienic
technique and prevent contact with infected
people. To protect thedebilitated patient from
secondary infection.
4. Bed rest. Bed rest is a necessary during the acute
phase. Encourage the pt. To gradually resume
normal activities as aymptoms subside to prevent
fatigue.
5. Provide emotional support for the pt. and family. If
the pt. Is on dialysis, explain the procedure fully.
Theses measures may help ease the pts.anviety.
6. The need for frewuent medical evaluation in
pregnant pts. With a hx of AGN.
7. The possibility of orthostatic hypotentsion when
taking diuretics and the need to change position
slowly.
8. The need for regular blood pressure, urinary
protien and venal fcn asssessments during the
convalesent months to detect recurrence.
9. The importance of immediately reporting signs of
infxn, such as fever and sore throat.
10. The importance of follow-up examinations to
detect chronic renal failure.